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成人非囊性纤维化支气管扩张症患者的预后因素。

Prognostic Factors in Adult Patients with Non-Cystic Fibrosis Bronchiectasis.

机构信息

Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.

Faculdade de Medicina, UFRGS, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.

出版信息

Lung. 2018 Dec;196(6):691-697. doi: 10.1007/s00408-018-0165-z. Epub 2018 Sep 25.

Abstract

BACKGROUND

Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease. There are few studies about prognostic factors in these patients. Our study aims to assess mortality rates and related factors in a cohort of patients and test the ability of the BSI and FACED scores in predicting mortality in this cohort.

METHODS

This was a prospective cohort analysis of 70 patients with NCFB recruited from May 2008 to August 2010. At baseline, patients underwent clinical evaluation, pulmonary function tests, 6-min walk test, and quality of life assessment. Outcomes were defined as favorable (survivors) and unfavorable (survivors who underwent lung transplantation and death from all causes). Baseline records provided data for determination of BSI and FACED.

RESULTS

Twenty-seven patients (38.57%) died and 1 (1.43%) underwent lung transplantation. Mean time for occurrence of unfavorable outcomes was 74.67 ± 4.00 months. Main cause of death was an acute infectious exacerbation of bronchiectasis (60.7). Cox regression identified age (p = 0.035; HR 1.04; CI 1.01-1.08), FEV % of predicted (p = 0.045; HR 0.97; CI 0.93-0.99), and MEP (p = 0.016; HR 0.96; CI 0.94-0.99) as independent predictors of unfavorable outcomes. FACED was better at predicting unfavorable outcomes in our cohort (log-rank test, FACED p = 0.001 and BSI p = 0.286). In ROC analysis, both scores were similar in predicting unfavorable outcomes (BSI 0.65; FACED 0.66).

CONCLUSIONS

Older age, lower FEV % of predicted, and lower MEP were independently linked to unfavorable outcomes. FACED and BSI were not accurate in predicting mortality in our cohort.

摘要

背景

非囊性纤维化性支气管扩张症(NCFB)是一种异质性疾病。关于这些患者的预后因素的研究较少。我们的研究旨在评估一组患者的死亡率和相关因素,并检验 BSI 和 FACED 评分在预测该队列死亡率方面的能力。

方法

这是一项对 2008 年 5 月至 2010 年 8 月期间招募的 70 例 NCFB 患者的前瞻性队列分析。基线时,患者接受临床评估、肺功能检查、6 分钟步行试验和生活质量评估。结果定义为有利(幸存者)和不利(接受肺移植和所有原因导致死亡的幸存者)。基线记录提供了确定 BSI 和 FACED 的数据。

结果

27 例(38.57%)患者死亡,1 例(1.43%)患者接受肺移植。发生不良结局的平均时间为 74.67±4.00 个月。死亡的主要原因是支气管扩张急性感染加重(60.7%)。Cox 回归分析确定年龄(p=0.035;HR 1.04;CI 1.01-1.08)、FEV %预计值(p=0.045;HR 0.97;CI 0.93-0.99)和 MEP(p=0.016;HR 0.96;CI 0.94-0.99)是不良结局的独立预测因素。在我们的队列中,FACED 更能预测不良结局(对数秩检验,FACED p=0.001,BSI p=0.286)。在 ROC 分析中,这两个评分在预测不良结局方面相似(BSI 0.65;FACED 0.66)。

结论

年龄较大、FEV %预计值较低和 MEP 较低与不良结局独立相关。在我们的队列中,FACED 和 BSI 不能准确预测死亡率。

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